Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce heart failure (HF) hospitalizations, recurrent cardiovascular events, and chronic kidney disease (CKD) progression, and thus constitute a Class 1a recommendation in people with diabetes and atherosclerotic cardiovascular disease, HF, or CKD and in people with severe albuminuria or HF, regardless of diabetes status. The purpose of this study was to comprehensibly characterize the rate of SGLT2 inhibitor prescriptions among people with a Class 1a recommendation for SGLT2 inhibitor use. Among 3,189,827 adults from 28 U.S. health systems within Optum Labs Data Warehouse between April 1, 2022, and March 31, 2023, we assessed SGLT2 inhibitor prescription rates, stratified by presence of diabetes and Class 1a recommendation. Among 716,387 adults with diabetes, 63.4% had a Class 1a recommendation for SGLT2 inhibitor therapy. There was little difference by Class 1a recommendation status (present: 11.9%; 95% CI: 11.9%-12.0% vs absent: 11.4%; 95% CI: 11.3%-11.6%; standardized mean difference: 1.3%). Among 2,473,440 adults without diabetes, 6.2% had a Class 1a recommendation for SGLT2 inhibitor therapy, and 3.1% (3.0%-3.2%) of those received a prescription. Internists/family practitioners initiated SGLT2 inhibitor prescriptions most commonly among people with diabetes, whereas specialists initiated SGLT2 inhibitor prescriptions most commonly among people without diabetes. No health system had >25% SGLT2 inhibitor prescription rate among people with a Class 1a recommendation. Health systems with higher proportions of patients with commercial insurance and lower proportions with Medicare had higher SGLT2 inhibitor prescription rates. In this analysis of U.S. data from 2022 to 2023, SGLT2 inhibitor prescription among people with a Class 1a recommendation is low. Interventions are needed to increase uptake of guideline-recommended SGLT2 inhibitor use.

中文翻译：

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美国卫生系统中钠-葡萄糖协同转运蛋白 2 抑制剂的处方模式


钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂可减少心力衰竭 (HF) 住院、复发性心血管事件和慢性肾病 (CKD) 进展，因此对糖尿病和动脉粥样硬化性心血管疾病、心力衰竭或 CKD 患者构成 1a 类推荐患有严重蛋白尿或心力衰竭的人，无论糖尿病状况如何。本研究的目的是全面了解 SGLT2 抑制剂使用 1a 级推荐人群中 SGLT2 抑制剂处方率。 2022 年 4 月 1 日至 2023 年 3 月 31 日期间，我们在 Optum Labs 数据仓库内的来自 28 个美国卫生系统的 3,189,827 名成年人中评估了 SGLT2 抑制剂处方率，并按是否存在糖尿病和 1a 级推荐进行分层。在 716,387 名成人糖尿病患者中，63.4% 的患者获得 SGLT2 抑制剂治疗的 1a 级推荐。 1a 级推荐状态差异不大（存在：11.9%；95% CI：11.9%-12.0% 与不存在：11.4%；95% CI：11.3%-11.6%；标准化平均差：1.3%）。在 2,473,440 名未患糖尿病的成年人中，6.2% 的人获得 SGLT2 抑制剂治疗的 1a 级推荐，其中 3.1% (3.0%-3.2%) 接受处方治疗。内科医生/家庭医生最常在糖尿病患者中开出 SGLT2 抑制剂处方，而专家最常在非糖尿病患者中开出 SGLT2 抑制剂处方。没有卫生系统在 1a 级推荐人群中的 SGLT2 抑制剂处方率达到 >25%。拥有商业保险的患者比例较高、医疗保险比例较低的卫生系统的 SGLT2 抑制剂处方率较高。在这次对美国的分析中 根据 2022 年至 2023 年的数据，1a 级推荐人群中 SGLT2 抑制剂处方较低。需要采取干预措施来增加指南推荐的 SGLT2 抑制剂的使用。